Progression Information and Consent

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Signature * This field is required.Triggers Some mental health topics could cause an emotional reaction from your teen, called a trigger. This is normal, and your teen may or may not experience a triggering reaction to the content of the classes. There is time set aside during each class to talk about triggers. You need to be aware that triggers may occur so you can talk to your teen, if they should experience one. I understand that NAMI Utah requires a trusted adult 18+ to be in the home when the participant is taking the course online.

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Signature* This field is required.Confidentially Disclosure I understand that though most of what happens throughout the Progression course is confidential there are exceptions including: if a participant shares they are thinking of harming themselves or someone else; if a participant shares that they have previously inflicted serious bodily harm on someone; or if a participant shares that they are being physically, sexually or emotionally harmed. In these situations parents/guardians and mental health professionals will be contacted for the safety of the participant. Teachers review the confidentially protocol with participants during the first class.

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Signature* This field is required.Permission to Attend Progression Because teens are minors, parents or guardians are required to give permission before they can attend the course. By signing below, I give permission for my teen to participate in Progression. I also understand that teachers will contact my teenager primarily through texting or email. If I have questions or concerns at any time throughout the course I may contact the NAMI Utah Programs Director, and author of Progression, Robin Holcomb at 801.869.2884 or robin@namiut.org.

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Parent/Guardian Name * Last Name * Phone Number * Email * How did you hear about Progression? *

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Participant First Name * Last Name * Age * Birth Date * Phone Number * Email * Affiliate/County * Street Address * Address Line 2 * City * State * Zip *

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Emergency Contacts* This field is required.Should there be an emergency of any sort during the Progression course we need to know who to contact. Please complete this form and be sure your teachers have it on or before the first day of class.

Name/Relationship

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Name/Relationship

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Name/Relationship

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